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CSteve ChiassonProgressive Developments in the Stabilization and Treatment of Problem Gambling

Steve Chiasson BA. CPGC1Presentation ObjectivesTo identify unique aspects and critical factors in the treatment of problem gambling To provide a comprehensive approach to stabilizing problem gambling and preparing clients for change To present an approach to treatment that is based on the integration of experiential knowledge and empirical evidence2Problem Gambling in PerspectiveFindings estimate that 332,000-449,000 Ontario adults have moderate to severe gambling problemsOnly 2% are in the formalized treatment system Clients receiving treatment commonly report numerous failed attempts to control or stop gambling, resulting in feeling perplexed, hopeless and resigned

3 Problem Gambling in PerspectiveActively gambling clients commonly report: Experiencing profoundly altered states both physically and mentallyDoing things they would have never believed that they were capable of doingNot grasping the magnitude of the negative consequences to their behaviours associated with gambling4Clinical ExperienceClinical experience includes working with over 2,100 clients over 15 years Extensive problem gambling group work, currently providing four therapy groups each week ( 52 clients in group services)Additional group: Mindfulness Meditation Practice5Main Clinical FrameworkBiopsychosocial perspectiveLearned behaviour modelCollaborative approachBased in principles of Motivational Enhancement (instilling hope and increasing self-efficacy)Externalization of the problemNormalize their experience - they are not alone

6reframe I'm stupidIm not my habitThe learning theory model focuses not so much on the internal workings of addiction such as physiology but, rather, on the thoughts (cognitions) and actions (behaviors) of individuals with addictions. The learning theory model asserts that addictive behaviors are developed in response to ones environment. The learning theory model includes (a) behavioral modalities, (b) cognitive modalities, and (c) cognitive-behavioral modalities, which is an integration of behavioral and cognitive modalities.

Theoretical Comparisons of P.GTwo General PerspectivesFirst PerspectiveTheories that assert the variations in gambling behavior result from variations in the characteristics or make-up of the individualBiological or genetic differences account for problem gamblingBlack and white distinction, the individual is either a compulsive/pathological gambler or not

7Theoretical comparisons contdSecond Perspective Theories that attribute excessive/problem gambling to psychological determinants and habitual processes such as Behavioral, Cognitive and Need-State models Some form of psychological mechanism accounts for disordered gamblingEmphasize the developmental and habitual nature of gambling rather than pathology

8Theoretical comparisons contdAvoids labels such as compulsive or addiction and instead makes reference to impaired control or disorder gamblingCentral to these theories is the idea that every person who gambles has the potential to become a problem gamblerNon-problematic gamblers may experience many of the same processes, but to a lesser degree

9Provincial Standard for Problem Gambling TreatmentCognitive - Behavioural TherapyGoals of CBTTo identify and raise awareness of cognitive distortions regarding gamblingChallenge the distorted thinking, i.e. the evidence that forms beliefs, thinking and expectations

10Cognitive Behavioural Model contdCognitive restructuring, i.e. correcting erroneous perceptions, beliefs and expectations regarding gamblingInitiating behavioural change

11Behavioural Cognitive TherapyEmphasis on the implementation of behavioural strategies to initiate change and to stabilize gambling behaviour. At this stage clients cognitive problem solving skills are typically not reliable/effective when applied to gambling and can in fact be a risk factor. Rather than a focus on critical thinking skills and correcting cognitive distortions BCT emphasizes behavioural strategies.

12Behavioural Cognitive Therapy contdCognitive strategies become more of a focus after the problem gambling behaviour has stabilized. CBT approach strategies are the core strategies for maintaining change.Central to this approach is a focus on risk management. Identifying and addressing risk behaviours and risk cognitions. 13Self Changers: What Worked? N=314David Hodgins University of CalgaryAction% of peopleNew Activities/Change in focus68%Stimulus Control/Avoidance48%Treatment37%Cognitive34%Budgeting31%Willpower/Decision-making/self-control23%Social Support10%Others confession, no money, non-gambling external factors, self-reward, spiritual, addressing other addictions